It’s been over five decades since the first artificial heart was implanted in a human. That device, handmade from plastic and connected to a 400-pound air compressor, kept a 47-year-old patient alive for 3 days until it was replaced by a donor heart.
The technology has evolved significantly, but the artificial heart is still seen as a bridge to transplantation and reserved for patients who are too sick to receive a real heart. Because the four- to six-hour open surgery required to implant the device is more complex than a heart transplant, with poorer overall outcomes, not many centers are willing to take on the challenge. In fact, only about 100 artificial hearts are implanted worldwide in a typical year.
At NYU Langone Health, however, the thinking is different. The NYU Langone Transplant Institute finds donor hearts faster than any other center in the Northeast, due in part to its innovative protocol for accepting and later treating otherwise healthy organs infected with hepatitis C. Moreover, with the highest one-year survival rate among heart transplant patients in the Northeast and the best outcomes among multiorgan transplants in the United States, it has been named the top heart transplant program twice in a row based on data published by the Scientific Registry of Transplant Recipients. So taking on patients whose only hope of survival is an artificial heart is a natural extension of its mission.
“When everybody else says no, patients can always rely on NYU Langone to look at the most complex cases,” says Nader Moazami, MD, chief of heart and lung transplantation and mechanical circulatory support. “We’re not afraid to say yes.”
The Transplant Institute’s inaugural artificial heart implantation, on March 31, was, in Dr. Moazami’s words, “as complex as it gets.” The patient, Floyd Gaskins, 55, a pastor from Vauxhall, New Jersey, has amyloidosis, a rare disease caused by the buildup of a protein that damages the body’s major organs. By the time Gaskins was transferred to NYU Langone from a referring hospital in New Jersey, he was in cardiogenic shock, a life-threatening condition in which the heart can no longer pump enough blood to meet the body’s needs. He had been on chronic dialysis, his liver function was declining quickly, and he had early-stage bone marrow cancer.
NYU Langone acted quickly, securing a SynCardia 70cc Total Artificial Heart (TAH) within a week and training a team of 143 clinical specialists on the device in just 2 days. “NYU Langone isn’t an ocean liner you can’t turn,” says Dr. Moazami. “When we decide to do something, we make things happen quickly. We have a remarkable team, one of the best in the world.”
Having worked with the manufacturer on investigational studies for the TAH while at another institution, Dr. Moazami was comfortable leading the procedure. With the patient on a heart–lung machine, Dr. Moazami and Deane E. Smith, MD, associate director of heart transplantation and mechanical circulatory support, removed both lower heart chambers and the four valves, positioned the device, sutured it into place, and connected tubes to the chambers of the original heart and the aorta. The artificial heart attaches to a tube that extends through the chest wall to an external pneumatic driver that does the pumping and monitoring.
Though designed as a temporary solution, the device has supported some patients unable to get a transplant for more than four years. One month after surgery, Gaskins was well enough to walk the halls at the Kimmel Pavilion, and on June 9, he received a heart–kidney transplant at NYU Langone. Gaskins will likely require chemotherapy to combat his amyloidosis—the next step on his path to recovery.
“This represents a critical, lifesaving option for patients who need a heart transplant but might not otherwise be candidates in other centers,” says Aubrey C. Galloway, MD, the Henry H. Arnhold Chair and Professor of Cardiothoracic Surgery.
The surgery sets up the Transplant Institute to participate in trials for other artificial heart devices currently in development and further bolsters its reputation. “He would not have received this care and treatment at any place other than NYU Langone,” says Robert Montgomery, MD, chair of surgery and director of the Transplant Institute. “This cements us as a top center that can do anything and everything for patients in heart failure.”